Bladder Control - Girls who "squat" to hold in their pee.

Pre-school and elementary school-aged girls who have problems with daytime wetting sometimes learn to squat down on the ground to prevent a soaker. 

A sudden contraction of the bladder takes them by surprise and the girls learn to sit on their heel to control the wetting. 

Sitting on their heel, pressing their thighs together, and pausing motionless increases the tension in the pelvic floor muscles, and this enables the child to control the amount of pee that comes out into their clothes. 

Changing a soaker into dampness sounds good. Less wet is better than soaked. Right? 

Wrong! 

The cost of squatting is a very high pressure in the bladder. Over time this high pressure can damage the bladder. The bladder wall gets progressively thicker and then irregular in appearance. The change in the bladder muscle affects how the bladder contracts and empties the urine. Emptying is compromised. 

From a bladder health perspective, squatting is bad. 

Squatting was first described in the UK in the middle of the last century. This behaviour was called Vincent's Curtsy Sign, because when a little girl in a dress crouches on the floor, this was reminiscent of a polite curtsy. This moniker makes the behaviour sound "cute," but squatting is neither cute nor healthy. 

Squatting is usually a marker for smouldering bladder infection. The inflammation due to the infection likely triggers the sudden spontaneous bladder contractions. In my experience infection is an ongoing concern in about 75% of girls who regularly squat. 

Girls who squat sit motionless for as long as it takes for the bladder contraction to pass. This can be more than a minute. The child sits motionless because they know that if they move at all, the control will be lost and a soaker will happen. Mothers report a variety of facial expressions, most of which clarify that the child is concentrating very hard on the behaviour. Sometimes the behaviour is painful and a child might be red-faced or have tears in their eyes.  

I consider squatting to be a "red flag" for the possibility of serious bladder problems. Always check for infection in a girl who squats.